A 34-year-old female presents for the first time to the outpatient clinic, complaining of a gradual increase in cough and SOB with wheezing for the past month. Her documented past medical history is notable only for seasonal allergic rhinitis. She notes that previously between attacks of her breathing difficulty, described as shortness of breath with wheezing, she would feel pretty normal. For the past year, she feels her breathing “isn’t what it used to be,” because episodes have become worse, and symptoms do not seem to fully resolve after attacks. She had been prescribed an albuterol inhaler that helps relieve the symptoms, but this has become a daily problem, and she has run out of her last prescriiption. She is also obese, and has been smoking 2 packs of cigarettes per day since the age of 16. No pets are in the home, and she denies having any prior or recent exposure to industrial chemicals.
On examination, she is afebrile, with a heart rate of 83 bpm, blood pressure 117/82 mm Hg, respirations of 18/min, and resting o2 saturation of 92%. She appears to be slightly uncomfortable, and is able to speak in sentences. Her lung examination is notable for mild wheezing that is worse with forced expiration, and no other adventitious sounds are noted on auscultation. A peak expiratory flow rate (PEFR) done in clinic was noted at 76% predicted.
1) In light of her reported intermittent symptoms by history, what is the patient’s most likely primary diagnosis?
2) What triggers asthma exacerbation?
3) ABG is not routinely required except three specific cases. What are they? indication of near intubation?
4) You would like to prescribe systemic steroid, which is better oral or IV? how much (amount) and duration?
